Vanderbilt University’s departments of Neurology and Neurosurgery are spreading the good news about deep brain stimulation (DBS) as an effective treatment for Parkinson’s disease, dystonia and essential tremor. Calling four seminars across the state the “DBS CME Roadshow,” Vanderbilt held its first evening session March 18 in Chattanooga and will repeat the session in Knoxville, Memphis and Nashville.

 

“Even though this technique has been around for more than 10 years, there are still a lot of patients who could be candidates for the therapy who don’t get it simply because it isn’t recognized as a good option,” said Joseph Neimat, MD, a Vanderbilt neurosurgeon and an instructor for the seminars. The roadshow’s purpose is three-fold:

 

“It just seemed reasonable to go out and set up a course where we could answer questions and educate them about the finer points of DBS,” Neimat said. He added previous community outreach efforts plus a growing network of physicians in the region already are resulting in referrals to Vanderbilt for the therapy.

 

Using DBS to treat Parkinson’s, dystonia and essential tremor is resulting is some “really dramatic results,” Neimat said. “In Parkinson’s disease, it’s usually used in patients who are beginning to have severe fluctuations on their medication, and it very nicely improves them. It’s as if they are getting their medicine steadily all the time.” Not only are tremors decreased or eliminated, but patients also are enjoying less stiffness and less difficulty moving around. They also are more alert and sleep better.

 

“In other diseases, it can be even more dramatic,” Neimat continued. “In tremor, often patients completely get rid of the tremor, and it is very gratifying when that happens. In dystonia, you can see improvements anywhere from 70 to 100 percent for their contracted limbs and postures.”

 

During the 1990s, Vanderbilt was one of the sites involved in early DBS trials. DBS was approved by the FDA for the treatment of essential tremors in 1997, for Parkinson’s in 2002 and for dystonia in 2003. Currently, the FDA is considering approval for a Medtronics DBS device to treat epilepsy.

 

Vanderbilt has been on the leading edge of introducing the procedure, said Neimat, who researched DBS during his training. In 2006, he completed a specialized fellowship on the therapy at the University of Toronto and then joined Vanderbilt’s faculty.

 

The DBS device is analogous to a pacemaker for the brain. “We’ve begun to understand that, like a heart when it’s misfiring, parts of the brain misfire and have an abnormal rhythm. If we can correct or alter that rhythm, we seem to be able to improve the disease,” Neimat explained. There are three components of the DBS device, all of which are implanted in the body. An electrode is implanted in the brain and connected to the pulse generator by an extension wire that runs down the side of the neck. The pulse generator is implanted below the skin usually just below the clavicle or sometimes in the abdomen.

 

Neimat said the beauty of DBS is that a microchip in the “pacemaker” controls the electrical stimulus based on adjustments made remotely by the physician. The voltage of the firing and the length of the firing may be turned up or down, and the speed of the firing may be adjusted. “Even after we’ve done the implantation, we still have the ability to adjust the stimulation to fine-tune the therapy,” he said. That flexibility – and the fact that DBS may be discontinued in a patient should a more promising therapy, such as stem cells, come along – ups patient enthusiasm for DBS, Neimat added. Because precise placement in the brain is critical, patients remain awake during the procedure so physicians may monitor the stimulation’s effects.

 

A next step for DBS is use in the treatment of depression. “We’re very interested in bringing that here. We have a neuro-modulation group, which is made up of a group of experts – neurosurgeons, neurologists, psychiatrists, ethicists – and we’re all working together,” Neimat said. Vanderbilt should be joining a DBS depression study with several other academic medical centers in the next six months, he added.